Impact of corporal experience on physiotherapy undergraduate students at the

Introduction : This study aimed to identify the experience aspects of physiotherapy undergraduate students at the Universidade Santa Cecília who attended “Corporal Experiences and Motor Coordination” classes in 2020. Methods : A total of 38 first year students were evaluated in a retrospective qualitative descriptive study. We used the students’ testimonials collected at two different moments of the classes as research data. We also asked the students if they were involved with any kind of physical practices such as high-level sports, somatic education training

Physiotherapy teaching focuses on its historical legacy. The profession sees theory as the most legitimate knowledge form, demonstrated by the weight it places on evidence from controlled tests and systematic reviews [5]. In this panorama, body awareness emerges as a scientific research topic around the vast number of health topics [6].
It is important that physiotherapy professionals and students experience practices for raising awareness and learning about body awareness, understanding its dynamics. In doing so, they will be able to pass on the knowledge and processes of this practice to patients, so that they can not only increase their therapeutic gains, but also avoid work injuries and perform work gestures more efficiently and with less energy expenditure.
It is known that the pedagogical process in the context of 'knowing, doing and being' allows students to develop multiple skills necessary for the complexity of the practice [4]. Therefore, it is expected that students (as future physiotherapy professionals) have a body awareness level which is not only capable of assisting in transposing theoretical knowledge into practice, but also in helping to develop autonomy towards clinical reasoning. Considering these issues, the present study aimed to identify the main aspects of the experience of students who attended the subject "Body Experience and Motor Coordination" at the Faculty of Physiotherapy of the Santa Cecília University (UNISANTA) in Santos, São Paulo, Brazil.

Methods
having participated in at least 75% of the workload of the subject "Body Experience and Motor Coordination" in the second half of 2020; being over 18 years old; have signed the Free and Informed Consent Form (ICF).
In addition to the inclusion criteria, factors such as professional sporting experience, yoga practice, Pilates or somatic techniques were considered; dancers and students with visual impairments were also controlled, as it is believed that these people can have a more sophisticated relationship with their own bodies in terms of awareness and sensitivity.

Procedures
A total of 38 of the 78 students who took the subject "Body Experience and Motor Coordination" in 2020 agreed to provide their bimonthly assessments as the data source for this retroactive study. All 38 students filled out a form for the characterization of the sample and signed a term of responsibility, which granted this study access to their assessments.
The course had practical and theoretical classes lasting one hour and 40 minutes per week throughout the second semester. Thus, sensorimotor exploration of the following bodily elements was practically addressed each week: feet, respiratory muscles, pelvis, perineum, pelvic girdle, shoulder girdle and trunk; work was also conducted on muscle chains, gait and motor coordination using materials for sensitization and support, such as broomsticks, cloths, tubes, tennis balls, etc. Part of these classes were taught in person and part remotely due to the COVID-19 pandemic.
In the first eight weeks, the 100-minute classes were online and in the last eight weeks, they were in person.
The teacher proposed a provocative question to the students to awaken reflection on their experiences as a form of bimonthly assessment. The question, which was the same in both tests was how the experiences they had had impacted on their bodies by asking "How much do you inhabit your body?"

Research instrument
Students who accepted to participate in the study answered an online form to characterize the sample. This form included questions to obtain participants' data on age, gender, and physical exercise habits.
Reports which were collected from students by the teacher as a 1st and 2nd bisemester evaluation were used for data collection. The first evaluation took place two Fisioterapia Brasil 2023;24(3);274-291 months after the beginning of the classes after the work on sensitization and perception of the body parts (feet, respiratory muscles, pelvis, perineum, pelvic girdle, shoulder girdle and trunk). The second evaluation took place two months after the beginning of the classes after the procedures involving theoretical-practical knowledge of muscle chains (GDS) and motor coordination (Béziers). The "Body Experience and Motor Coordination" subject was taught for the first time in 2020 as part of the Physiotherapy course curriculum at the Universidade Santa Cecília. In developing the content of this discipline, under the guidance of Professor, students went through an awareness and perception process of their own body through principles and practices of somatic education, mostly based on the works of Ivaldo Bertazzo [7,8], Marie Madeleine Béziers [9], and according to the Muscle Chains approach by Godelieve Denys Struyf (GDS) [10].
As they do not contain a single or exact answer, the testimonies flowed in an authentic, personal, and intimate way, revealing individual choices which enabled a deeper understanding of the researched subject.

Data analysis
Bardin's Content Analysis Method was used to analyze the data [11]. According to it, a first full reading of the testimonies of each student was performed to understand their experiences and obtain the general meaning of their reports. Then, a second more attentive and investigative reading was conducted to find common registration units in the testimonies to all or part of them. These registration units were mostly nouns, for example: pain, care, relief, posture, breathing, attention; and verbs, for example: feel, perceive, recognize, care. The excerpts containing these registration units were separated and then placed into categories according to the analogical regrouping based on the analysis of the descriptions of the students' reports.
Analog regrouping resulted in relational axes, as proposed by Bardin Nominal categorical data were presented in relative and absolute frequency. Fisioterapia Brasil 2023;24(3);274-291

Results and discussion
As for the quantitative data in relation to the characterization of the sample of 38 participants, 26 identified themselves as female (ƒr = 0.68) and 12 as male (ƒr = 0.31); two said they practiced physical exercise (ƒr = 0.05), while 36 reported not practicing (ƒr = 0.95). It is important to remember that the study took place during quarantine with social isolation due to COVID-19. A total of 35 of the participants answered yes (ƒr = 0.92) regarding having practiced regular physical exercise in the past, while only three said no (ƒr = 0.07). Among the activities performed, they reported combat (jiu-jitsu and karate), dancing (ballet, jazz, street dancing and contemporary dance), weight training, swimming, running, cycling, soccer or a combination of two or more of these practices.
One of the participants was blind. We believe that, because the participants are physiotherapy students, the practice of some physical exercise is common in this type of population and they were the ones who proposed to participate in the research because they probably felt more comfortable in saying what they felt about their bodies although, in the period of the pandemic, most said they were not exercising.
For the qualitative results analyzed, Bardin's Descriptive Method [11] was used.
The "Relationship with Yourself" category concerns the perceptions, changes, and discoveries that the students had in their bodies as an instance of themselves, as well as the reflections based on these topics. It is divided into three subcategories: Selfknowledge, Self-Perception, and Quality of Life.
The Self-knowledge subcategory describes the repercussions beyond the physical scope of body awareness. It reflects the activity's contribution to personal processes which result in bodily changes in relation to yourself, such as self-care, and which raise reflections on life and on what you want for yourself; it also rehearses a body/mind junction.
The following excerpts taken from the testimonies illustrate aspects that enable us to observe how the students' experience with bodily experiences and the somatic education techniques practiced in the "Body Experience and Motor Coordination" subject is related to the Self-knowledge subcategory. The reports were preserved in their original forms in Portuguese, and then translated into English.
"The whole self-knowledge process that we went through [with the classes] made us feel that we also have our problems, difficulties and limitations to be improved, thus bringing the reflection that we are all equal." In this study, the Self-perception subcategory reflects the parts of the statements that reflect body awareness, portraying an achievement of more sophisticated attention to body parts which are now sensitized. It also portrays attention to improved movements and postures adopted in daily life. These reports also reflect the difficulty in perceiving one's own body, as in the following excerpts: "Due to the difficulty and exercises, I reflected on how much I pay attention to and take care of my body. I concluded that very little, almost never, and that's why the classes did me very well for self-knowledge and care." "The classes showed me that I still have a lot to know about my own body, that there were places I didn't even know I could feel." "In some cases I didn't even know I had such difficulty if I hadn't stopped to pay attention (...) I noticed details that I had never noticed and/or paid attention to myself, details that made a difference, but which went unnoticed in everyday life due to the lack of attention I had to my own body." According to Mehling et al. [4], although people naturally go through an appropriation process of the body during psychomotor development, this process can be interrupted or disturbed, hence the need for these somatic education techniques. The testimonies of the students revealed compliance with this trend in the process: "After the classes, the lack of control I had in relation to stability and movements [of the pelvic girdle] in its axes was very noticeable." "I noticed lost flexibilities during my body's maturation, pain that arose due to the practice of sports etc." The weekly routine of silencing the body in the face of external interference, together with detailed bodily self-investigation, enabled expanding the perception of bodily processes. The increase in body perception was observed in the studies by Bretas et al. [12] and those by Lima Cecchini et al. [14] in studies in which nursing and physiotherapy students respectively began to participate in bodily experience classes.
"When walking, running, I pay attention to correct stepping; despite getting a little sore due to the contraction of the tibialis anterior, I always remember the position. (...) I also started to pay more attention to the pelvis and pelvic girdle, which we find rigid, the simple fact of sitting, balance and position. We even forget they exist." more present, so that I can study my body and understand how important it is to feel our bodies; not only areas which are frequently stimulated, such as the hand, arms, feet and legs, but also our spine, the pelvic region, our trapezius, meaning those areas [in] which we can release the fascia." "As the classes went on, the results got better, especially in terms of breathing, axial growth and posture." "When we put the balls on the ischium (sitting bones), the touch was not deep as we didn't literally touch the bones, but when we took the balls out, we felt the bone a lot, completely changing our posture, our way of sitting, etc." "The difference between the beginning and the end of the class was remarkable, I was much more present." "The practices allowed me to attentively perceive parts of my body that were once tacit, taking care of each one of them respecting and knowing their particularities. (...) [ they allowed me to perceive] how the distraction is harmful to them and to the body as a whole. Today, I learn from classes as a form of relaxation, intimacy and care." "I had the opportunity to observe parts of the body that I really didn't pay attention to, for example when walking or running, as simple care and attention help to significantly improve correct movement, cushioning and correct conduct, benefiting all involved parts, such as muscles, joints and nerves." By noticing the fixation of movement patterns and postures, which introduce discomfort and tension, the students were able to discriminate them from postures and movements made consciously, with less effort and with less energy expenditure. This perception -as well as questioning about the efficiency of their choices -opened the way to decondition the gesture and for experiencing new alternatives, resulting in an increase in the body repertoire, as explained by Balsanello [13]. According to Lima Cecchini et al. [14], the experiences enable recognizing tense areas of the body and the increase in body awareness makes it easier to act to relax the body more effectively. "In the classes, I not only learned to get to know my body better, but also not to be ashamed of myself, of how I am, and I even came to accept it when I couldn't do something the way I wanted due to lack of coordination or skill. I understood that I don't need to be perfect, that in fact there is no such thing as perfection, and that excessive demands can do more harm than good. Testimonials like these are also found in the work of Bretas et al. [12] and Lima Cecchini et al. [14]. Self-care skills, changes in habits and emotional response patterns are reported by participants in the study by Mehling et al. [4] and appear as a quality that should continue to be practiced. In this category, words such as empathy, responsibility and respect emerged. According to their reports, students were able to share these experiences with other people, such as family, friends or university colleagues, obtaining good results.
"I tried to put it into practice with other people, I tried to understand the difficulty of each one, I found that a simple movement changed their daily lives a lot." "Treat others as well as yourself with responsibility, empathy and love, these are the three basic topics that (sic) I learned to have in class." "I learned to teach classes more patiently and pass on to my little dancers what I learned. I started to reflect with them, make them less agitated and more focused." The study by Mehling et al. [4] also found that the participants' relationship with other individuals changed with therapy and attributed this change to better selfownership. In addition, these researchers mention that the experience provides greater openness and rapport among the participants, providing an environment which favors exchange, better interaction and socialization in the group. These findings also occur in the study by Bretas et al. [12], and were also verified in this study: "There was an activity in which you should wake up one of your colleagues and give them a hug, providing a closer relationship with the colleagues and a welcoming moment." "The bodily experiences have shown that I must help whoever is in need and when I need someone I wait for the same. I learned to share experiences with classmates and external people (family, friends, acquaintances)." The Relationship with Physiotherapy category sought to draw the parallel made by students between their bodily experiences and physiotherapy from their own role in the dynamics to points on learning and how practical classes managed to translate the concepts learned.
Regarding the therapist-patient relationship, there was a concern about understanding the body processes and in the body itself in all the statements, meaning in itself, to be able to have references and transmit the same sensations to future patients. The following are excerpts from some of the testimonies that revealed this care: "I could see it in class, especially when I had to do all the procedures on someone else, at that moment I realized how much I needed to be aware of all this to be able to make the person feel the same well-being that I could feel when it was with me." This perception also happens with Nursing students in the study by Bretas et al. [12], when he says that the best body perception on the part of the therapist outlines references for better understanding of the patient, taking them out of the condition of objectification.
Regarding learning, and corroborating the study by Bretas et al. [12], students reported a better association of theoretical contents when they are experienced, or perceived, in their own bodies. This feeling, which is also given emotional meaning, thus becomes a pathway to learning, as the students reported in this study. "In the other classes we have at the Faculty, we know our body structurally and try to imagine how it all fits in us (...) the experiences were felt, we put all the parts to really work, it was something that came from the outside to the inside and even though the touch was the most superficial it requires the most attention and that makes it have a real and profound impact on us." "In the bodily experiences classes, in addition to using some theories and knowledge that we have acquired in other classes, we are also able to understand our bodies in personal practice and, for sure, passing this on to another person will be even more complete, efficient and human." "It's content I've never tried, and I'd like to see there continue to be classes that have concepts of modalities like this, where we can interact, learn, enjoy the results in our own bodies and in a fun and didactic way." These reports corroborate what Barradell [5] states about the need for new approaches in teaching physiotherapy, implementing approaches which promote different ways of obtaining knowledge, development of identity and collective practices. According to Barradell [5], these approaches must result from recognizing the complex relationship between knowing and knowing how, valuing a culture where it is created, where it is shared and where new and different forms of knowledge are used. From this perspective, physiotherapy teaching will no longer be practice-oriented and will become practice-based.
Students in the present study also highlighted the need for emotional and physical engagement in learning processes, which means that not only the mind, but also the student's body must be present and participatory: "The experiences brought a perception about my body that is movement, deconstructing already formed conceptions and introducing a different look, a look of transformation, I started to look at myself from the inside out, look at learning. That's when I managed to analyze that being part of this movement is making the body essential for learning experiences." The Relationship with pain category was created in this study because, although pain is an afference, a sensation, it is important to report how the students' body perception before the body experiences classes was only linked to the presence of this sensation or to pathological processes, as can be seen in the excerpts: "The practical experiences [had] an impact on the attention we do not give to our bodies due to the daily rush, causing us to unintentionally divert this attention and only "remember" when we trigger some kind of pain or discomfort in a certain region of the body." "One point that goes unnoticed is our own breathing. We only notice it when we have a cold, the flu. Today, after the body experience classes, I understand and do it every day. It's body relaxation." As a result of their research, Mehling et al. [4] point out that it is pain and other symptoms which lead patients to seek somatic education techniques such as therapy.
After the body experience procedures, students who used to feel a lot of pain reported a decrease in these sensations. They also mentioned autonomy and proactivity to solve the problem when they practiced the exercises proposed in the experiences in their daily lives and when they showed interest in sharing the benefits of the practice with others.
"The practices carried out during the classes had a good result for my body, helping to eliminate pain or local discomfort." "I was able to stand for longer which was very difficult before, I felt pain in the hip region and in the dorsal region of the spine, I was able to sleep better without feeling so much pain during the night. I started to sit without difficulty, before I could not do it for a long This relationship between somatic education practices and pain relief was also found in the investigation by Lima Cecchini et al. [14], according to which all Physical Therapy students who participated in the study reported decreased pain sensation after engaging in the activity. The desire to pass on knowledge found in the study by those authors was also mentioned by the participants of this study.
Although one of the pillars of this study is body perception as an instance of oneself, the Relationship with the body category appears separate from the Relationship with yourself category, as the body was cited in many reports as an object foreign to itself, an object of which if it makes use. It was common to find a dissociation of what the participants called problems and deficits of the body itself as limitations of themselves in the testimonies. The lack of association between the body's needs and their own needs was also common. They did not realize that helping/improving their own body is actually helping/improving themselves. These findings pointed to the fact that despite an increase in the perception of one's own body, there is no appropriation or incorporation of it.
Examples of this dissociation appear in the following excerpts: "Through the practices I was able to assess certain limitations in my body such as lack of general flexibility from the sole of the foot to the back of the leg." "I got to know better about my own body and different ways of how to 'help' it to adapt better in different situations." "I didn't take some care with it [my body] in some parts, but then after the classes I had with the teacher, I started to be more careful and that helped me in my daily life, as in the way I walk, stepping on the ground." "I learned that the body needs time for it, that it is important to calm it down and respect it, which made me reflect a lot, disconnect my body a little from the acceleration that daily tasks overload it." "I got to know my body better, I started to realize what it asks for, its importance, and especially to take care of it more gently." "The practice of movements had a positive impact, as I gained a broader knowledge of my body, leaving it much lighter and looser after the exercises." "Thanks to the classes given, I was able to acquire a much greater perception of my body and thus be able to understand it better, consequently being able to take better care of it and in the future take care of other peoples' bodies." "The experiences not only affected my body, but also the way I relate to it." Although in many testimonies it was possible to observe a line of reasoning that was still dichotomous in body/mind, it was also possible to verify that this practice started a more unified and integral orientation of the being: This dissociation between body and mind is also brought up in the research by Mehling et al. [4] in which somatic therapists show concern with the expression of body awareness, as it emphasizes the physical aspect. The term embodiment conveys the idea of appropriating the body as an incorporation of the mind. The patients interviewed in that study have at least six months of practice and report the experience of this incorporation into their lives, demonstrating the need for practice, repetition, and training for the integration process.
As limitations of this study, we highlight the refusal of 40 of the 78 students to participate in this research, which, despite being confidential, may have caused discomfort since the students' tests would be analyzed. Even though the grades are not considered a failing factor, some students may have felt inclined to write about a positive impact in the assessments. In addition, the expanded body perception and the discussion about the sensations found is an exercise that needs constant practice so that, at each stage, the student can better translate their new discoveries into words. As it is the first contact of most students with this type of study, many were unable to accurately and clearly elaborate their perceptions of their learning. A point to be highlighted is also that the same bodily perception can be reported in quite different ways, such as what happens with heart attack pain, which can be described as feeling a stab wound to the chest or as a feeling of anguish and deep sadness.

Conclusion
With this study, it was possible to conclude that the tools used in the "Body Experience and Motor Coordination" classes enabled students to experience the body in a different way than usual, with greater sophistication and attention to themselves.
Intimate contact with the body and the perception of previously neglected functions, such as breathing, contributed to the students obtaining self-control strategies and relief from physical and emotional tension, implying a positive impact on their lives and bodies.
Regarding physiotherapy, the study showed that experiences with an emphasis on somatic education broaden the reflection about the body, both as an instance of oneself and in relation to the treatment and care of the other's body. The theoreticalpractical experience added to this reflection mobilizes a new way of access to learning, which suggests a different approach for teaching the contents studied in the health area.

Conflicts of interest
There are no conflicts of interest to report.